Provider Demographics
NPI:1114358819
Name:COUTURE, ROBERT J JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:COUTURE
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3116
Mailing Address - Country:US
Mailing Address - Phone:315-651-9317
Mailing Address - Fax:
Practice Address - Street 1:42 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3116
Practice Address - Country:US
Practice Address - Phone:315-651-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 311529164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse